HomeMy WebLinkAboutX2017-0772 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application
r Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building F_ Grading j-Drainage Elec Mech
Vum Cu Yd Cut Cu Yd Fill F_
Project Address (Not mailing address) C Flood
r Fire r Liq F- Landslide F-N/A Floor Suite No
Description of Work
Us��onstTy
# Stori s ` # Units (if Res)r—
Valuation
Material/tabor
New/Add SFi Remodel SFr— Garage/New/Add F
OWNER'S NAME Last e7 uc,
C
First Y
Owner's Address
Owner's E-mail Address
City A2k JT State GA
Zip F Telephoned
APPLICANT'S NAME Last r��tn
First a(Ifl^ce.
Applicant's Addre�sss
Applicant's E-mail Address
City ✓IA'F��-FJ✓1 �G�A, State FET
Zip q�6 Telephone71U�(.��0.466
I 1 I ULic.
�it1D rESIGNER'S N�rAM�I E Last k(n 6M, bl-V 5, First 7�pjkj No. F_
Architect/Designer's Address
r� / SS
Architect/Designer's E-mail Address
City ,/Xy�.�y-/.�- State 4 2:
Zip 7 �'t� Telephone e �� �j
����
ENGINEER'S NAME Last i U t„ _ First I � � Lic. No.l � , 31
v�
, IJ
Engineer's Address
Engineer's E-mail Address
Ij,�_9-0 _ rt)J AIM
City G U State C1
Zip Telephone 1�
/
Lic.No. 111-� Class FRE
CONTRACTOR'S NAME/COMPANY d QR ii Ll O&NVUC1IU,
Contractor's Address
C tractor's E-mail Address
IS131 16+100 -
City U%�t_N�'�ovl.. OC _ State C ---
Zip 7 Telephone
SETBACKS REAR SETBACKS FRONT
PERMIT NO. .�1b0Ito •3P�Iq
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. 919ci i •Zp Ito
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $
5 C30t!a A I I cx1 -